Complications of Chronic TBI: Physical Therapy Management of a Patient with Chronic TBI after Cardiac Arrest and Associated Hypoxic Brain Injury

Background: Traumatic brain injury (TBI) is a complex pathology resulting in a multitude of functional consequences. Little is known, however, about chronic TBI, its associated complications, and rehabilitation for either. The purpose of this case report is to present options for physical therapy (PT) evaluation and treatment in an outpatient care setting for a patient following complications of chronic TBI. This report contains information for approximately the first 3 months of the plan of care. Case Description: The patient is a 58-year old male with history of severe TBI 18 years prior to the current episode of care. Following successful acute rehabilitation with acquisition and sustenance of functional independence, the patient suffered a functional decline. Later, he experienced cardiac arrest and associated hypoxic brain injury as complications of chronic TBI. The patient initiated care at an outpatient neurorehabilitation clinic. Interventions during his 30 sessions of care were comprised of strengthening exercises, balance training, gait training, cardiovascular endurance training, safety awareness education and training, and home exercise program initiation. Outcomes: The patient demonstrated notable improvement using multiple outcome measures. The TUG Test decreased from 23.9 seconds to 12.3 seconds. The 5TSTS Test decreased from 49.6 seconds to 20.9 seconds. A distance of 1,003 feet (305.7 meters) was achieved during the 6MWT following the inability to complete the measure at initial evaluation. Discussion: With little research available to inform evaluation and treatment decisions, this report provides a unique example of care for a complex patient case. The selected interventions were clinically and subjectively remarkable to restoring the patient’s status. Future research into chronic TBI, its complications, and its PT management would be beneficial in furthering knowledge on this topic matter.